Conquering Infertility: Dr. Alice Domar's Mind/Body Guide to Enhancing Fertility and Coping with Infertility

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About ten years ago, at a time in my career when I was completely entrenched in infertility both in terms of the patients I was treating and the research I was conducting, a good friend called to tell me that she was going to have a baby. Without thinking, I replied, "That's wonderful! So how did you get pregnant?" My mind was on Clomid, IUI, and IVF. "What do you mean, how did I get pregnant? The same way everybody gets pregnant!" It turns out she'd conceived the old-fashioned way and was shocked thinking that I was asking about the intimate details of what position they'd used, which room of the house they'd conceived in, and so on. It hadn't occurred to my friend that someone would get pregnant any other way than by having unprotected sex. And it hadn't occurred to me, at first, that someone could actually get pregnant simply by having sex.

Does this sound familiar to you?

If it does, and if you are thinking these days that sex and pregnancy seem to be completely unrelated, you need to read this book.

If you have to get off the phone quickly so you can hide your tears when your best friend calls to say she's pregnant, you need to read this book.

If you find yourself constantly becoming angry at your mother for not "getting it," or you worry about your reaction the next time someone tells you to just relax and you'll get pregnant, or you've lost interest in your job, or you can't stand it that everyone you know is pregnant, you need to read this book.

If you feel sad more than you feel happy, if you find yourself wondering if the guy you married has a sensitive bone in his body because his life seems to go on even after you get your period, if you find you worry constantly about seeing a pregnant woman on the street or being surprised by a pregnancy announcement, if you really wonder whether you will ever be happy again, you need to read this book.

Infertility stinks. It can be an all-encompassing heartbreak that leaves you feeling isolated, depressed, angry, and hostile. But I'm here to tell you that you don't need to feel that way. You can learn to pursue infertility treatment without feeling as if your life and body have been taken over. You can learn to talk with your husband calmly and rationally and to make decisions that are best for both of you. You can learn how to decrease the stress-related symptoms such as insomnia and headaches that further decrease the quality of your life. And believe it or not, you can actually learn to laugh during infertility.

This book is designed to give you back your life. As you read along, I want you to think, "I thought I was the only one who felt like that!" or "I thought my husband and I were the only ones reacting to infertility in such an unhealthy way!" or "I feel as if you know me-my situation is being described on every page!" And I want you to come to the realization that you are going to be OK, that there are lots of things you can do to help yourself feel better. Infertility can seem like the ultimate loss of control. In this book I will teach you how to take control of your infertility, your body, your relationships, your mind, and your soul.

This book is the result of sixteen years of work on infertility. I began doing research on the impact of stress-reduction techniques on infertility in 1986, and started my first mind/body infertility group in 1987. I published my first paper summarizing my research in 1990. I published two books on stress reduction for women and cowrote, along with two physicians, a book on infertility in which one chapter is dedicated to the mind/body connection. But it really wasn't until now that I felt ready to put all those years of experience conducting research and group and individual therapy into book form. Before I wrote a book on this subject, I wanted to have conducted the research and thoroughly examined all the literature on the connection between stress and infertility. I wanted to treat as many patients as possible so that I could reference stories that would have meaning to every reader. I wanted to be able to say that I think I've heard everything-all the myths surrounding infertility, the insensitive comments people make, the desperate actions patients take, and the ins and outs of modern medical treatment.

Finally, I wanted to learn enough from my research and clinical practice to give infertility patients hope. And now I can do that. This I know for sure, based on sixteen years of research and clinical work with thousands of infertility patients:

You will be happy again. Life will become joyful again. And somehow, some way, if you want to become a parent, you will.

People often ask me why I've made infertility my life's work. It all started with my mother and the tremendous impact her infertility had on my family. In the 1950s, when my mother had trouble conceiving, her doctors were unable to tell her why she wasn't getting pregnant, and they had little to offer her in the way of treatments. These days medical science has so many more answers for infertile women. Reproductive endocrinologists can count sperm, measure its motility, determine the time of ovulation, evaluate the health of eggs, analyze hormone levels, and inspect the fallopian tubes, ovaries, and cervix for abnormalities. Once a suspected problem is uncovered, doctors can often correct it. Surgery can remove cysts and obstructive scar tissue, and drugs can boost hormone secretion and spur ovulation. If conception still fails to occur, physicians can offer infertile couples a range of assisted-reproductive technologies that the women in my mother's generation could never have dreamed of.

But with all of today's wonderland of technological treatments for infertility, something important is missing. Despite the many medical achievements of the past decades, very little progress has been made in treating the emotional side effects of infertility. When my own mother was trying to become pregnant, she felt depressed, anxious, and isolated. She was left to bear the emotional strains of infertility alone. Amazingly, that continues to be true of many infertile women today. In just about every major city in the world, you can find clinics full of doctors who can diagnose and treat infertility. But it's much harder to find a physician who will help you cope with the anger, jealousy, sadness, confusion, and profound yearning that accompany infertility.

After years of trying, my parents finally conceived my sister. Five and a half years later, after they had pretty much given up the dream of having a second child, I arrived. And although my parents certainly didn't dwell on their experience with infertility, I grew up with an acute awareness of the effect it had had on them and on us as a family. My parents frequently talked about how infertility had affected them-and about how much they treasured my sister and me because they had almost abandoned any hope of having children.

I believe that my mother's experience with infertility indirectly helped shape my career choices. As the director of the Mind/Body Center for Women's Health at Boston IVF, I design and lead mind/body workshops that have helped thousands of women cope with the stress of infertility. These programs, which have drawn participants and media attention from around the world, teach infertile women dozens of relaxation techniques, stress-management strategies, and other mind/body skills that help alleviate the strain of coping with infertility and boost pregnancy rates.

My journey into mind/body medicine started early. As a child, I always wanted to be a doctor, but as I got older, I also knew that I was particularly interested in helping people emotionally. When I finished college, I couldn't decide whether I could better reach my goal as a psychologist or as a physician. So I took two years off to make up my mind. During that time I worked for two doctors: a neurologist and a psychologist who were doing brain research at Children's Hospital in Boston. I figured that working for both a psychologist and a neurologist would help me decide which career path to take.

During those years it became very clear to me that although I was interested in medicine, what really fascinated me was the emotional aspect of disease. As I looked at brain scan after brain scan, I was drawn not to diagnosing pathology but to helping the people whose scans I was studying. I wanted to meet the patients and families who were struggling to cope with disease and help them survive its emotional punch. So I chose to become a psychologist, and I enrolled in the health psychology program at the Albert Einstein College of Medicine/Ferkauf School of Professional Psychology of Yeshiva University in the Bronx. When it came time to choose medical specialties, I picked OB/GYN. Amazingly, I was the first person in the history of my health psychology program to choose this specialty-which says a lot about how little attention had been paid to the connection between mind and body in the field of women's health.

My twin interests in women's health and health psychology led me to the Mind/Body Medical Institute in Boston, where I began working with Dr. Herbert Benson, the father of mind/body medicine. That's when everything came together for me, and I realized that I could use my medical expertise, my psychological training, my personal life lessons, and my empathy to help women to cope with both the psychological and physiological challenges presented by their medical conditions. Over the years, as I have worked on mind/body clinical programs and research projects, I have recognized something that is crucial when it comes to successfully treating women's medical conditions: Women's minds must be treated along with their bodies. That is true no matter what causes their suffering, whether it is infertility, cancer, insomnia, chronic pain, AIDS, or menopause. To separate mind from body, to treat one without attending to the other, is foolish and ineffective. When you treat a woman's mind as well as her body, almost without exception she feels better and can cope more effectively with her condition. And in some cases her symptoms and prognosis improve.

In case after case after case we find that the women who learn to use mind/body strategies to manage the stress of infertility dramatically reduce their levels of depressive symptoms, anxiety, anger, and frustration. When infertile women learn to use simple techniques that allow them to relax, transform negative thought patterns, express their emotions, and develop strong sources of social support, they begin to take control of their lives again. They feel significantly less isolated and desperate. They sleep better, their relationships with their husbands improve, and they suffer from far fewer stress-related ailments such as gastrointestinal problems or insomnia. What's more, as I have shown in a number of studies published in peer-reviewed medical journals, they are more likely to get pregnant.

But getting pregnant is not the focus of this book. This book is about how infertile women can reestablish control over their lives. What feels most threatening to women experiencing infertility is being out of control. They can't control their fertility, they can't control their emotions, and in many cases they can't even control when they're going to make love to their husbands. They feel that their lives are falling apart, their careers are in shambles, and their personal relationships have withered-all because infertility has chipped away at their emotional health. The mind/body approach that I teach in my classes and in this book helps women regain control. Sometimes it helps them get pregnant, too-but making infertile women feel better is my primary goal. Pregnancy, if it occurs, is just a happy side effect.

In this book I'll provide you with an experience that is as close as possible to actual participation in one of my ten-session mind/body infertility programs. Central to my approach is the "relaxation response," our inborn capacity to reduce internal stress. I'll explain a variety of easy-to-learn ways to elicit the relaxation response, including meditation, mindfulness, yoga, body scan, progressive muscle relaxation, and autogenic training. I'll also show you the value of dozens of lifestyle changes, thinking strategies, and social approaches that you can use to help you deal with infertility. Not all of them will be right for you, and that's okay. When it comes to mind/body coping and relaxation strategies, I like to think that I'm offering a buffet of choices. The first time you go up to the table, you try a little of everything, and the next time you take just what you like. Here's an example: For some people meditation is a godsend-several of my patients say meditation has saved their lives. But others can't quiet their minds enough to enjoy meditation, and for them a yoga class is a far more effective way to bring peace to their agitated psyches.

I'll also take a close look at the connection between depression and infertility. Evidence is mounting that not only are depressive symptoms a very common side effect of infertility, but they may also impede your chances of getting pregnant as well. I'll help you determine whether you are depressed and, if you are, give you a variety of strategies to alleviate your symptoms.

In addition, I'll discuss the many issues that can cause emotional turbulence for infertile couples, including finances, difficulties with health-care providers, the differences between male and female approaches to facing infertility, the toll infertility can take on your career, lack of understanding among family and friends, jealousy, anger, and spiritual concerns.

You'll hear the voices of many women who have struggled with infertility. These women have endured-and survived-infertility by using mind/body techniques to help bring joy back into their lives. They have worked hard to strengthen their marriages, rebuild friendships, revitalize their careers, and make peace with their situations. Some have been wonderfully successful, and others continue to struggle. Most have become parents; others are learning to accept being childless. All of them are truly inspiring, and I hope that by reading their stories you'll not only learn the power of mind/body techniques but feel less isolated as well. Perhaps you'll even feel inspired to reach out to join a support group with other infertile women.

You'll also meet individuals who have decided to take less-traveled roads to parenthood. Some of them have chosen to adopt children, from either the United States or abroad, and others have become parents with the help of donated eggs or sperm. You may think that these options aren't right for you, but I urge you to put those thoughts aside and come back to them later. Many of the women who begin my program are hell-bent against anything but genetic, biological motherhood. But as they use mind/body techniques to restructure their thinking and to open lines of communication with their spouses, they sometimes discover that those other options are more palatable than they had originally thought.

Mind/body techniques aren't a magic wand that will make you pregnant. But they are an excellent, effective way to help you take back control of your life, cope with your infertility in a much more positive way, and prepare yourself to make choices that will contribute to your happiness and good health for the rest of your life.

Chapter One
Infertility,Stress, and Depression

When I logged on to my computer this morning, I took a quick look at my e-mail and found the usual collection of messages: a memo from a co-worker, a meeting reminder, a note from my sister, and some junk mail peddling stock tips that could make me rich-I wish! Then I saw a message from my good friend Cathy. The subject line, bad news, jumped out at me, so I opened the message and read it immediately.

"Got my period this morning. L!"

Her message was just five words-six if you include the doodad-and yet it told me so much. Even though Cathy didn't say "I feel so depressed!" or "What are we doing wrong?" or "Why is this happening to us?" I knew she was probably thinking these things. I knew that she most likely had cried her eyes out when those first few drops of blood of her period appeared, and that it probably took all the energy she could summon just to drag herself to work. And I know that if she sees a pregnant woman today, or hears a baby cry, or glimpses a picture of an infant on a co-worker's desk, her tears will return. When she gets home from work tonight, she's likely to snap at her husband, skip her workout, and spend the rest of the evening on the couch numbing herself with junk food and junk TV, trying to forget how bitterly disappointed she is that yet another month has gone by and she's still not pregnant.

I know this because I've seen it happen thousands of times.

Being unable to get pregnant is one of the most stressful things a woman can go through. Most of us, until we start trying-and failing-to get pregnant, assume that if and when we want children, we'll have them. As little girls we rock dolls in our arms and pretend to be mommies. As we grow up and become sexually active, we walk a shaky tightrope, assuming that the slightest slip could plunge us into an unwanted pregnancy. Yet we also feel completely confident that if we are smart about contraception we'll maintain complete control of when we will or won't get pregnant-we believe that it's all solidly in our own hands.

As newlyweds we think about when we'll start "trying," and we chat endlessly with girlfriends and sisters about whether it's better to give birth in spring or summer and which we'd rather have first, a girl or a boy. Then, once we finally do go off the Pill or toss aside the diaphragm or leave the condoms in the nightstand drawer and set out to make a baby, it's nothing but fun. A little champagne, some candles, some sexy lingerie, and after a few thrilling nights of unprotected lovemaking, we fully expect to be well on our way to a darling little baby. "After all, I don't shoot blanks," our husbands boast playfully. And as we wait for that first period not to arrive, we smile conspiratorially at women with babies and then march confidently off to the drugstore for a pregnancy test, happily anticipating a plus sign.

And then, for some women, nothing happens.

So you try again-but with the tiniest sliver of worry. You may pay more attention to the calendar and plan some extra midcycle sex. You nix the champagne and pop a few extra vitamins instead. But still, the next month, nothing happens. So you buy ovulation kits and cut out caffeine and ask friends for advice. You may exercise less (or more), eat less (or more), and insist that your husband wear boxers instead of briefs-and tough luck if they feel bunchy. "Deal with it," you think. You wonder whether you should make an appointment with your OB/GYN, or perhaps even a specialist. You fixate over what you could possibly be doing wrong. You have sex constantly. And yet your period keeps arriving, right on schedule. Getting pregnant can start to become an obsession. As you fail to conceive, cycle after cycle after cycle, your anxieties may begin to haunt you, as negative thoughts loop endlessly through your mind. You blame yourself, your body, for failing, even though it may well be your husband's body that is the source of the problem. The content of those negative thoughts differs from woman to woman, but they're all related, a laundry list of should-haves and shouldn't-haves. We should have started trying earlier. I shouldn't have drunk so much in college. My husband shouldn't have experimented with pot. I shouldn't have had an abortion in my twenties. I should have taken better care of myself. Eventually your relationship with your husband starts to suffer. The thrill of frequent sex has worn off, and when your husband comes home from work exhausted on day twelve of your cycle, you tell him that you don't care how tired he is, he's doing it tonight if it kills him. You're panicked about not being able to conceive, but he's laid back. Don't worry, he tells you. It will happen. Just relax and stop obsessing about it. But you can't.

Then your best friend gets pregnant. She calls, all excited, prattling on and on about the names she's picked out and the darling crib she wants to buy and how excited her parents were to find out they're going to be grandparents. You pretend to be happy for her, but deep down inside you're insanely jealous, and you can't get off the phone fast enough. You're racked with guilt. You find yourself avoiding her and everyone else who has children. You just can't bear facing them. You are stressed out. You may feel depressed, anxious, or angry. You might have trouble concentrating at work, and you may even cry every day. You begin to wonder if you'll ever have a baby, and if you'll ever be happy again. Your whole world is falling apart-just as it did for my patients Brenda and Janine.

Brenda's Story

Brenda, thirty-five, had been trying to have a baby for three years. She conceived naturally three times, but each pregnancy ended in miscarriage. Then she couldn't even get pregnant for about a year, despite infertility-drug treatment and several intrauterine inseminations (IUI). "I was extremely depressed, although it's only in hindsight that I realize how depressed I was," Brenda says. "My husband kept telling me to see someone, to take something-but I never wanted to see anyone, because I was afraid they'd try to put me on an antidepressant, and since I was trying to get pregnant, I didn't want to do that. And I didn't want to see a therapist, because I knew what was wrong with me: If I could just have a baby, I'd be happy. I didn't need to go sit and whine in someone's office about not having a baby. I just knew that if I had a baby, I'd be happy, and if I didn't have a baby, I wouldn't be happy."

As time went on, Brenda became more depressed. "I wouldn't buy furniture or clothes, or I wouldn't plant flowers in the garden in the springtime-I wouldn't do anything I loved to do. I felt that until I had that baby, I couldn't do anything else. I was paralyzed and frozen. It was really hard for my husband to see me miserable all the time. He felt so helpless-he'd try to buy me things or do things for me, but nothing made me feel better."

Janine's Story

"I totally thought I'd get pregnant right away-my mother always got pregnant at the drop of a hat. Her nickname was 'Fertile Myrtle,' " says Janine, a now-forty-four-year-old adult-education instructor who started trying to conceive on her honeymoon. "I was so shocked that first month when I got my period." After six months Janine still was not pregnant. That's when it started to dawn on her that she might not be fertile. "I started reading, investigating, looking at my options, and talking to people."

During the following months she underwent a raft of painful tests, procedures, and treatments, including three IUIs. She tried acupuncture and changed her exercise routine, but nothing worked. "I was sad but not depressed. I would cry a lot when I talked to my husband or my mother about it. It was very emotional. But at the same time I really hated all that prodding and poking." For Brenda and Janine, infertility was one of the worst experiences of their lives. But by joining my infertility program, by learning to relieve some of the stress of infertility, and by figuring out how to surround themselves with the love and support of family, friends, and other infertile women, Brenda and Janine conquered their infertility. That's what I'm going to help you do, whether you've been trying to get pregnant for six months or six years. With the dozens of mind/body techniques, coping strategies, and lifestyle changes in this book, I'll help you conquer infertility, too.

—from Conquering Infertility: Dr. Alice Domar's Mind/Body Guide to Enhancing Fertility and Coping with Infertility by Alice Domar, Copyright © October 2002, Viking Press, a member of Penguin Putnam, Inc., used by permission